射频消融对非瓣膜病心房颤动患者肾小球滤过率的影响

Effect of radiofrequency catheter ablation on estimated glomerular filtration rate in patients with atrial fibrillation

目的探讨射频消融术对非瓣膜病心房颤动患者肾小球滤过率(e GFR)的影响。方法应用前瞻性研究方法,选取行射频消融术的心房颤动患者121例,其中阵发性心房颤动组105例,持续性心房颤动组16例。应用酶法化验血清肌酐,应用CKD-EPI方程计算e GFR,所有患者均行射频消融术(环肺静脉电隔离+线性消融),术前评估e GFR、血红蛋白、高敏C反应蛋白、氨基末端B型钠尿肽,应用超声心动图测量入选者左心房直径、左心房面积、左心室射血分数。术后6月及12月进行上述所有数据的随访,统计分析射频消融术后维持窦性心律对心房颤动患者e GFR的影响。结果两组在年龄、性别、体质指数、高血压病、糖尿病、血脂异常、食盐情况等方面比较均无统计学差异(P>0.05),两组心房颤动病程比较具有统计学差异(P<0.05)。与术前基线比较,射频消融术后6月、12月两组左心房直径、左心房面积减小,左心室射血分数增加,血红蛋白、高敏C反应蛋白、氨基末端B型钠尿肽降低,e GFR增加(P<0.05)。与术前基线比较,射频消融术后6月、术后12月阵发性心房颤动组左心房直径、左心房面积减小,左心室射血分数增加,血红蛋白、高敏C反应蛋白、氨基末端B型钠尿肽降低,e GFR增加(P<0.05)。与术前基线比较,持续性心房颤动组射频消融术后6月、12月左心房直径、左心房面积减小,左心室射血分数增加,血红蛋白、高敏C反应蛋白、氨基末端B型钠尿肽降低,e GFR增加,差异均有统计学意义(P<0.05)。结论射频消融转复心房颤动患者窦性心律可提高心房颤动患者肾小球滤过率,改善心房颤动患者肾功能。

Aim To investigate the effect of radiofrequency catheter ablation on glomerular filtration rate in patients with nonvalvular atrial fibrillation（AF）. Methods A prospective study was conducted in 121 patients with atrial fibrillation who underwent radiofrequency ablation,including 105 patients with paroxysmal atrial fibrillation and 16 patients with persistent AF. Enzyme assay was applied to measure serum creatinine,e GFR was calculated by using CKD-EPI equation,all patients underwent radiofrequency ablation（circumferential pulmonary vein isolation＋ablation）,e GFR,hemoglobin,high sensitive C-reactive protein,N-terminal natriuretic peptide were assessed preoperatively,left atrial diameter,left atrial area and left ventricular ejection fraction were measured by echocardiography. All the data were followed 6 and12 months after operation,and the effect of sinus rhythm after radiofrequency catheter ablation on e GFR in patients with atrial fibrillation was analyzed statistically. Results There was no statistical difference in age,sex,body mass index,hypertension,diabetes,dyslipidemia and salt（P〉0.05）,while there was statistical difference in AF time（P〈0.05） between the two groups. Compared with preoperative baseline,left atrial diameter and left atrial area decreased,left ventricular ejection fraction increased,hemoglobin,hypersensitive C-reactive protein,N-terminal natriuretic peptide decreased,e GFR increased（P〈0.05） in two groups 6 and 12 months after radiofrequency catheter ablation. Compared with preoperative baseline,left atrial diameter and left atrial area decreased,left ventricular ejection fraction increased,hemoglobin,hypersensitive C-reactive protein,N-terminal natriuretic peptide decreased,e GFR increased（P〈0.05） in paroxysmal atrial fibrillation group 6 and 12 months after radiofrequency catheter ablation. Compared with preoperative baseline,left atrial diameter and left atrial area decreased,left ventricular ejection fraction increased,hemoglobin,hypersensitive C-reactive protein,N-terminal natriuretic peptide decreased,e GFR increased in persistent AF group 6 and 12 months after radiofrequency catheter ablation. The differences were statistically significant（P〈0. 05）. Conclusion Radiofrequency ablation of sinus rhythm can improve the glomerular filtration rate and the renal function in patients with atrial fibrillation.